Document Detail


Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation.
MedLine Citation:
PMID:  23061393     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The aim of this study was to define the optimal treatment for patients with symptomatic intraluminal carotid artery thrombus (ICAT).
METHODS: The authors performed a retrospective chart review of patients who had presented with symptomatic ICAT at their institution between 2001 and 2011.
RESULTS: Twenty-four patients (16 males and 8 females) with ICAT presented with ischemic stroke (18 patients) or transient ischemic attack ([TIA], 6 patients). All were initially treated using anticoagulation with or without antiplatelet drugs. Eight of these patients had no or only mild carotid artery stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography; of these, 10 underwent delayed revascularization (8 patients, carotid endarterectomy [CEA]; 2 patients, angioplasty and stenting), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs after treatment. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation therapy, either during the perioperative period or in the long-term follow-up; 1 patient died of an unrelated condition. The mean follow-up was 16.4 months.
CONCLUSIONS: Results of this study suggest that initial anticoagulation for symptomatic ICAT leads to a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.
Authors:
Ananth K Vellimana; Yasha Kadkhodayan; Keith M Rich; DeWitte T Cross; Christopher J Moran; Allyson R Zazulia; Jin-Moo Lee; Michael R Chicoine; Ralph G Dacey; Colin P Derdeyn; Gregory J Zipfel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-10-12
Journal Detail:
Title:  Journal of neurosurgery     Volume:  118     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-02     Completed Date:  2013-03-12     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-41     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticoagulants / therapeutic use
Aspirin / therapeutic use
Brain Ischemia / drug therapy,  radiography,  surgery,  therapy*
Carotid Arteries / radiography,  surgery*
Carotid Artery Thrombosis / drug therapy,  radiography,  surgery,  therapy*
Carotid Stenosis / drug therapy,  radiography,  surgery,  therapy*
Cerebral Angiography
Endarterectomy, Carotid
Female
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Retrospective Studies
Stroke / drug therapy,  radiography,  surgery,  therapy*
Treatment Outcome
Warfarin / therapeutic use
Grant Support
ID/Acronym/Agency:
P50 NS055977/NS/NINDS NIH HHS; P50 NS055977/NS/NINDS NIH HHS; R01 NS051631/NS/NINDS NIH HHS; R01 NS051631/NS/NINDS NIH HHS; U01 NS058728/NS/NINDS NIH HHS; U01 NS58728/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 5Q7ZVV76EI/Warfarin; R16CO5Y76E/Aspirin
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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